Provider Demographics
NPI:1043974769
Name:SD HEALTH AND ACUPUNCTURE
Entity type:Organization
Organization Name:SD HEALTH AND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ATSUSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANOMATA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-888-5310
Mailing Address - Street 1:3717 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113
Mailing Address - Country:US
Mailing Address - Phone:619-888-5310
Mailing Address - Fax:619-839-3620
Practice Address - Street 1:2180 GARNET AVE
Practice Address - Street 2:SUITE 1I
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:619-432-2477
Practice Address - Fax:619-839-3620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty